Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study
Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on...
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| Veröffentlicht in: | Perfusion 2020-03, Vol.35 (2), p.138-144 |
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| creator | Argiriadou, Helena Antonitsis, Polychronis Gkiouliava, Anna Papapostolou, Evangelia Deliopoulos, Apostolos Anastasiadis, Kyriakos |
| description | Introduction:
Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing.
Methods:
A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass.
Results:
ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02).
Conclusion:
Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity. |
| doi_str_mv | 10.1177/0267659119866289 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2268575039</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0267659119866289</sage_id><sourcerecordid>2353473944</sourcerecordid><originalsourceid>FETCH-LOGICAL-c365t-6fdaeb6d15864cf84ae7438599e86a29eb690aca2846fd6c636f6697f50e27fa3</originalsourceid><addsrcrecordid>eNp1kc1r3DAQxUVpSDbb3HsKhl56cSNZsj56K0vbFBJySaA3MyuPFi9e25HsJXvLn57ZbNpAICfBvN97mg_GPgv-TQhjLnihjS6dEM5qXVj3gc2EMiYXQvz9yGZ7Od_rJ-w0pTXnXCklj9mJFNJYIeWMPV43XbOBNmu6LaRmixk-jBF8H4c-ItV9E_3Uwtj0XTZETBi3mLKBKtjimIWp888ahBFj5iHWDfgsTXGFcfc9AzL1aUCCKLtf7v3PYRSdxqnefWJHAdqEZy_vnN39-nm7uMyvbn7_Wfy4yr3U5ZjrUAMudS1Kq5UPVgEaJW3pHFoNhSPNcfBQWEWo9lrqoLUzoeRYmAByzr4ecqmf-wnTWG2a5LFtocN-SlVRaFuakktH6Jc36LqfInVMlCylMtLRGueMHyhPA6aIoRoibTLuKsGr_XWqt9chy_lL8LTcYP3f8O8cBOQHIMEKX399N_AJl9mafQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2353473944</pqid></control><display><type>article</type><title>Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study</title><source>MEDLINE</source><source>SAGE Journals</source><creator>Argiriadou, Helena ; Antonitsis, Polychronis ; Gkiouliava, Anna ; Papapostolou, Evangelia ; Deliopoulos, Apostolos ; Anastasiadis, Kyriakos</creator><creatorcontrib>Argiriadou, Helena ; Antonitsis, Polychronis ; Gkiouliava, Anna ; Papapostolou, Evangelia ; Deliopoulos, Apostolos ; Anastasiadis, Kyriakos</creatorcontrib><description>Introduction:
Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing.
Methods:
A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass.
Results:
ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02).
Conclusion:
Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.</description><identifier>ISSN: 0267-6591</identifier><identifier>EISSN: 1477-111X</identifier><identifier>DOI: 10.1177/0267659119866289</identifier><identifier>PMID: 31378133</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Anticoagulants ; Bleeding ; Cardiac Surgical Procedures - methods ; Circulation ; Coagulation ; Correlation coefficient ; Correlation coefficients ; Extracorporeal Circulation - methods ; Female ; Heart ; Heart surgery ; Hemostasis ; Hemostatics ; Heparin ; Humans ; Integrity ; Male ; Middle Aged ; Observational studies ; Platelet Function Tests - methods ; Platelets ; Preservation ; Prospective Studies ; Protamine sulfate ; Surgery ; Test procedures ; Thrombocytopenia ; Titration</subject><ispartof>Perfusion, 2020-03, Vol.35 (2), p.138-144</ispartof><rights>The Author(s) 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-6fdaeb6d15864cf84ae7438599e86a29eb690aca2846fd6c636f6697f50e27fa3</citedby><cites>FETCH-LOGICAL-c365t-6fdaeb6d15864cf84ae7438599e86a29eb690aca2846fd6c636f6697f50e27fa3</cites><orcidid>0000-0002-5451-4651</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0267659119866289$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0267659119866289$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31378133$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Argiriadou, Helena</creatorcontrib><creatorcontrib>Antonitsis, Polychronis</creatorcontrib><creatorcontrib>Gkiouliava, Anna</creatorcontrib><creatorcontrib>Papapostolou, Evangelia</creatorcontrib><creatorcontrib>Deliopoulos, Apostolos</creatorcontrib><creatorcontrib>Anastasiadis, Kyriakos</creatorcontrib><title>Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study</title><title>Perfusion</title><addtitle>Perfusion</addtitle><description>Introduction:
Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing.
Methods:
A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass.
Results:
ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02).
Conclusion:
Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.</description><subject>Anticoagulants</subject><subject>Bleeding</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Circulation</subject><subject>Coagulation</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>Extracorporeal Circulation - methods</subject><subject>Female</subject><subject>Heart</subject><subject>Heart surgery</subject><subject>Hemostasis</subject><subject>Hemostatics</subject><subject>Heparin</subject><subject>Humans</subject><subject>Integrity</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Platelet Function Tests - methods</subject><subject>Platelets</subject><subject>Preservation</subject><subject>Prospective Studies</subject><subject>Protamine sulfate</subject><subject>Surgery</subject><subject>Test procedures</subject><subject>Thrombocytopenia</subject><subject>Titration</subject><issn>0267-6591</issn><issn>1477-111X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1r3DAQxUVpSDbb3HsKhl56cSNZsj56K0vbFBJySaA3MyuPFi9e25HsJXvLn57ZbNpAICfBvN97mg_GPgv-TQhjLnihjS6dEM5qXVj3gc2EMiYXQvz9yGZ7Od_rJ-w0pTXnXCklj9mJFNJYIeWMPV43XbOBNmu6LaRmixk-jBF8H4c-ItV9E_3Uwtj0XTZETBi3mLKBKtjimIWp888ahBFj5iHWDfgsTXGFcfc9AzL1aUCCKLtf7v3PYRSdxqnefWJHAdqEZy_vnN39-nm7uMyvbn7_Wfy4yr3U5ZjrUAMudS1Kq5UPVgEaJW3pHFoNhSPNcfBQWEWo9lrqoLUzoeRYmAByzr4ecqmf-wnTWG2a5LFtocN-SlVRaFuakktH6Jc36LqfInVMlCylMtLRGueMHyhPA6aIoRoibTLuKsGr_XWqt9chy_lL8LTcYP3f8O8cBOQHIMEKX399N_AJl9mafQ</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Argiriadou, Helena</creator><creator>Antonitsis, Polychronis</creator><creator>Gkiouliava, Anna</creator><creator>Papapostolou, Evangelia</creator><creator>Deliopoulos, Apostolos</creator><creator>Anastasiadis, Kyriakos</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5451-4651</orcidid></search><sort><creationdate>202003</creationdate><title>Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study</title><author>Argiriadou, Helena ; Antonitsis, Polychronis ; Gkiouliava, Anna ; Papapostolou, Evangelia ; Deliopoulos, Apostolos ; Anastasiadis, Kyriakos</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-6fdaeb6d15864cf84ae7438599e86a29eb690aca2846fd6c636f6697f50e27fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anticoagulants</topic><topic>Bleeding</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Circulation</topic><topic>Coagulation</topic><topic>Correlation coefficient</topic><topic>Correlation coefficients</topic><topic>Extracorporeal Circulation - methods</topic><topic>Female</topic><topic>Heart</topic><topic>Heart surgery</topic><topic>Hemostasis</topic><topic>Hemostatics</topic><topic>Heparin</topic><topic>Humans</topic><topic>Integrity</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Platelet Function Tests - methods</topic><topic>Platelets</topic><topic>Preservation</topic><topic>Prospective Studies</topic><topic>Protamine sulfate</topic><topic>Surgery</topic><topic>Test procedures</topic><topic>Thrombocytopenia</topic><topic>Titration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Argiriadou, Helena</creatorcontrib><creatorcontrib>Antonitsis, Polychronis</creatorcontrib><creatorcontrib>Gkiouliava, Anna</creatorcontrib><creatorcontrib>Papapostolou, Evangelia</creatorcontrib><creatorcontrib>Deliopoulos, Apostolos</creatorcontrib><creatorcontrib>Anastasiadis, Kyriakos</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Perfusion</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Argiriadou, Helena</au><au>Antonitsis, Polychronis</au><au>Gkiouliava, Anna</au><au>Papapostolou, Evangelia</au><au>Deliopoulos, Apostolos</au><au>Anastasiadis, Kyriakos</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study</atitle><jtitle>Perfusion</jtitle><addtitle>Perfusion</addtitle><date>2020-03</date><risdate>2020</risdate><volume>35</volume><issue>2</issue><spage>138</spage><epage>144</epage><pages>138-144</pages><issn>0267-6591</issn><eissn>1477-111X</eissn><abstract>Introduction:
Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing.
Methods:
A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass.
Results:
ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02).
Conclusion:
Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31378133</pmid><doi>10.1177/0267659119866289</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5451-4651</orcidid></addata></record> |
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| ispartof | Perfusion, 2020-03, Vol.35 (2), p.138-144 |
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| source | MEDLINE; SAGE Journals |
| subjects | Anticoagulants Bleeding Cardiac Surgical Procedures - methods Circulation Coagulation Correlation coefficient Correlation coefficients Extracorporeal Circulation - methods Female Heart Heart surgery Hemostasis Hemostatics Heparin Humans Integrity Male Middle Aged Observational studies Platelet Function Tests - methods Platelets Preservation Prospective Studies Protamine sulfate Surgery Test procedures Thrombocytopenia Titration |
| title | Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study |
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